Multidisciplinary Approach to the Management of an Extracranial Internal Carotid Artery Aneurysm Approaching the Base of the Skull in a Young Patient

Internal carotid artery aneurysms are rare in young patients, especially those without connective tissue disorders or vessel trauma. We present the case of a 29-year-old man who was referred for an asymptomatic pulsatile mass. Computed tomographic angiography identified a true aneurysm between the carotid bifurcation and the base of the skull. This location combined with extensive perineural fibrosis made dissection difficult. Collaboration with an otolaryngologist provided enough distal internal carotid artery exposure for a saphenous vein interposition graft to be placed. Despite initial cranial nerve dysfunction, which later resolved completely, the patient tolerated the procedure well and remains asymptomatic 2 years postoperatively.